Understanding Disparity: The Role of Social Vulnerability Index and Social Determinants in Orthopedic Surgical Outcomes

Author(s): Kevin Babakhan Vartanian, Tony Eskandar, Vahe Yacoubian, Devendra K. Agrawal

While clinical factors are traditionally considered central to orthopedic surgical outcomes, emerging literature highlights the significant impact of social determinants of health. Factors such as socioeconomic status, education, housing and community environment substantially influence patient recovery and post operative outcomes. This review evaluates three validated indices, the Social Vulnerability Index, Area Deprivation Index, Distressed Communities Index, and their association with orthopedic surgical results. Recent studies consistently demonstrate that higher scores in these indices correlate with increased postoperative complications, prolonged hospital stays, higher emergency department visits, elevated readmission rates, and greater mortality risk across orthopedic subspecialties including joint arthroplasty, trauma surgery, and spine surgery. Specifically, the social vulnerability index robustly predicts postoperative complications and increased healthcare resource utilization. Area deprivation index similarly forecasts extended hospitalization and institutional discharge rates, although its link to short-term complications varies. Distressed communities index reliably indicates higher healthcare resource use, though its predictive strength for specific surgical complications remains inconsistent. Despite these correlations, research limitations persist, notably retrospective study designs, inconsistent methodologies and difficulties integrating area level indices with individual patient data. Nevertheless, incorporating social risk assessments into clinical evaluations represents a crucial avenue to reduce disparities and enhance orthopedic patient care.